SIAPS conducted this assessment to determine the extent to which pharmaceutical information generated from the Electronic Dispensing Tool (EDT) and dashboard is used by key stakeholders in the national antiretroviral therapy (ART) program in making decisions regarding the management of medicines and related services and, to the extent possible, identify potential influences on program outcomes. The assessment used a descriptive case study approach based on 28 interviews conducted with key stakeholders in the national ART program and a desk review of program-related documents and publications.

SIAPS has supported the Division: Pharmaceutical Services to conduct support supervisory visit (SSVs) to monitor and assess progress of the supported programs and provide recommendations to further strengthen implementation of pharmaceutical service delivery. The SSVs are used to monitor the extent of implementation of interventions aimed at strengthening pharmaceutical services in MRMDs, hospitals, and primary health care (PHC) facilities; identify challenges in the services; provide onsite support; and make recommendations to address the challenges. These visits are carried out once a year, and the SSV teams check whether issues identified from previous visits have been addressed. SIAPS has supported the MOHSS to implement strategies to strengthen the inventory management of antiretroviral (ARV) medicines and the ART pharmaceutical system. A stronger inventory management system will enable the country to cope with the scale-up of ART services, which increased quantities of health commodities and more complex inventory management tasks.

SIAPS helped improve pharmaceutical product quality by building the capacity of the Namibia Medicines Regulatory Council (NMRC) to review medicine registration dossiers; inspect pharmaceutical manufacturing facilities and finished (imported) products at ports of entry and in the marketplace; to chemically test medicines compliance with established standards; and monitor overall compliance with applicable regulatory standards and norms. In addition, SIAPS supported MOHSS in strengthening the management and regulation of medical devices and support equipment in Namibia, and in revising the National Medicines Policy, a crucial of pharmaceutical regulation and governance. SIAPS supported the reconfiguration of the desk-top Pharmadex tool to a web-based application. In general, the six-year support of the SIAPS project to the NMRC contributed to the strengthening of this regulatory agency, which in turn, contributed to improvements in service delivery to the clients. The registration process improved, to decrease the long-standing backlog of dossiers; PMS ensured safety and quality of pharmaceuticals; and implementation of web-based Pharmadex provided a means for clients/applicants to upload applications and follow up the progress of dossier review, which reduced workload for NMRC staff. SIAPS provided continuous TA for the restructuring of the NMRC.

The use of antiretrovirals (ARVs) in combination for treating patients with HIV has greatly ameliorated morbidity and mortality by reducing viral load to undetectable levels and boosting the body’s immunity. However serious adverse reactions causing long- or short-term effects have been associated with ARV treatment. These reactions have caused major concerns internationally, potentially threatening patient adherence to long-term treatment. The duration of treatment of patients infected with HIV; co-morbid conditions, such as tuberculosis (TB) and malaria; and the complications due to HIV infection or AIDS make it difficult to determine the exact cause of the adverse events (AEs) experienced by patients taking ARV medicines. The prevalence of co-morbid conditions differs across socioeconomic groups and geographical regions, which may contribute to differences in ARV toxicity profiles. Hence, it is recommended that national HIV treatment programs establish population-level ARV toxicity profiles for their countries. Therefore, with increased survival of patients and the long-term duration of antiretroviral treatment (ART), it is important for national pharmacovigilance centers to monitor the immediate and long-term effects of these ARVs on the population. A simple, practical, and cost-effective method for evaluating the safety of drugs approved for human use is the spontaneous reporting of AEs to a pharmacovigilance center. This method is helpful for identifying serious and rare medicine-associated AEs. The evaluation of these AEs informs regulatory decisions on improving the safety of medicines in the country and globally. The objective of the Analysis of Namibia Therapeutics Information and Pharmacovigilance Centre’s Data was to identify drug safety concerns associated with the use of antiretroviral medicines in Namibia’s HIV treatment program, by analyzing pharmacovigilance data generated from spontaneous reports of suspected adverse events (AEs).

The SIAPS-developed AMR coalition-based strategy identifies educational institutions, such as UNAM; therapeutic committees (TCs); and key institutions involved in AMR, such as the National Institute of Pathology (NIP) as key players in the pre- and in-service training of health care professionals to enhance RMU and combat AMR. SIAPS collaborated with key institutions, including the MoHSS, Div:PhSs, UNAM-SOM, UNAM-SOP, NIP, and TCs in the Kunene and Karas regions, in activities to reduce hospital-acquired infections (HAIs); improve infection prevention and control (IPC); and promote RMU in Namibia.

SIAPS has supported the ART program and the Division of Pharmaceutical Services to implement ART decentralization strategies. SIAPS has collaborated with other USAID-funded implementing partners in the development of standard operating procedures (SOPs) for implementing CBART services and in designing process flows for the movement of patients between the community and ART facilities, including pharmacy visits for ARV refills. SIAPS trained more than 80 health workers in PEPFAR priority, high HIV prevalence regions on the SOPs and process flows for CBART implementation, dispensing tools, and procedures at NIMART sites. SIAPS has also supported the ART program by developing monitoring and evaluation tools to ensure that the care provided to patients accessing services from community service points and NIMART sites is well documented to allow health practitioners at the main ART sites to ensure that patients still receive the same high standard of care required in the delivery of ART services.

SIAPS supported the MoHSS to design and implement a web-based electronic information system (dashboard) for both patient and stock status in Namibia. It was designed to improve coordination among facility, district, regional, and national stakeholders involved in HIV commodity management; increase the use of pharmaceutical information for management decision making at all levels of health care; and improve planning for financial resources for pharmaceutical commodities. The dashboard comprises a module for monitoring 22 pharmaceutical services delivery indicators, a module that summarizes the number of people accessing ART services, and an early warning system against stock-outs of antiretrovirals (ARVs) and other essential medicines.

Although SIAPS introduced a number of automated inventory control tools, such as the Facility Electronic Stock Card (FESC) and Electronic Dispensing Tool (EDT) for district hospitals, since June 2015, at the primary health care (PHC) level, inventory control and storage practice are a major challenge and the major cause of stock-out of medicines for antiretroviral therapy (ART), tuberculosis (TB), and malaria in all regions in Namibia. To ameliorate these challenges, the MOHSS has revised and distributed standard operating procedures (SOPs) for the management of medicines and medical supplies at PHC facilities in the period of 2015–16, and training on these SOPs has been provided to all staff at the PHC level in the Khomas, Ohangwena, and Otjozondjupa regions in the months of May, June, August, and November 2017. A training was needed to improve inventory control and good storage practices, thereby improving access and restraining increases in the pharmaceutical budget by reducing expiries and damaged pharmaceuticals and at the same time building the training capacity of the regional pharmacists. Facilitation of these trainings was supported by the SIAPS technical advisor. The trainings aimed to improve the management of ARVs, TB medicines, and related health commodities. It was necessary to improve inventory control and good storage practices, thereby improving access and further reducing the increasing pharmaceutical budget by reducing cases of expired and damaged pharmaceuticals.

SIAPS supported the Ministry of Health and Social Services to enhance capacity of pharmaceutical HR to manage pharmaceutical services in public health facilities in Namibia. The major objectives of the activities were to build HR capacity in pharmaceutical management and service delivery for improved HIV and AIDS treatment outcomes and improve availability and use of pharmaceutical service data for improved quality of ART services. Activities comprised onsite staff mentoring through supportive supervision visits and training sessions adapted to the needs of the target healthcare workers.